[Staging and profiling in bipolar disorders]

Bipolar disorders are expressed in a wide variety of forms and last for different lengths of time. This has a major influence on diagnosis and treatment and on the interpretation of research findings.

To propose and describe a method for staging and profiling of bipolar disorders.

We searched the literature for evidence of attempts to define stages of illness progression and risk factors that determine the course of illness.

The staging of bipolar disorders evolves from a symptom-free phase with high-risk conditions to a treatment-resistent chronic mood disorder. A family history of recurrent mood disorder, affective symptoms in childhood and depression in adolescence strongly predict future bipolar disorder. The profiling system that we propose incorporates not only clinical phenomenology in accordance with current classification but also clinically relevant predictors for an unfavorable course of illness. These predictors include age at onset, cognitive profiles, comorbidity, traumatic life events, psychosis, suicidality, insight into illness, and respons to treatment. There is some emerging evidence for genetic or other biological markers.

Staging and profiling may contribute to early diagnosis, preventive strategies, and personalised treatment and may provide guidance for further research.